Diffuse large B-cell lymphoma combined with hyperlactatemia presents high mortality: case report and literature review

Abstract

Diffuse large B-cell lymphoma (DLBCL) can present with hyperlactatemia or even lactic acidosis (LA) as a rare but often underrecognized complication among hematologists. Patients diagnosed with DLBCL complicated by LA generally exhibit high mortality and a poor prognosis, even with therapeutic intervention. This report details two cases of DLBCL concurrently presenting with LA and provides a literature review. Our analysis of 19 published studies revealed a survival advantage in patients with an initial lactate levels of 5–14.9 mmol/L compared to those with levels of 15–24.9 mmol/L. Furthermore, the maximum lactate level correlated with survival, with higher values predicting shorter survival times. For type B LA, early initiation of chemotherapy-based treatment significantly improved patient survival compared to other treatment approaches (P = 0.026). Adjunctive treatments such as sodium bicarbonate, thiamine, and vitamin B may also be beneficial. Careful attention should also be paid to avoiding medications that can increase lactate levels.

Keywords

diffuse large B-cell lymphoma / hyperlactatemia / lactic acidosis

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